Módulo Medios diagnósticos para el Sistema de Información Hospitalaria XAVIA HIS / Diagnostic Means Module for the XAVIA HIS Hospital Information System

El Sistema de Información Hospitalaria XAVIA HIS desarrollado por el Centro de Informática Médica (CESIM) está compuesto por módulos que aseguran la informatización de los procesos de las áreas de la institución hospitalaria. En la actualidad la gestión de los principales medios de diagnóstico se realiza de forma dispersa en diferentes módulos o sistemas. En este trabajo se presenta el módulo de Medios de Diagnóstico, desarrollo que permite la gestión de informes de solicitudes y resultados de forma configurable, así como la planificación de horarios y gestión de citas. Se analizó el proceso de negocio asociado a la gestión de información de medios de diagnóstico, se realizó un estudio de sistemas existentes con propósitos similares y se evaluaron tecnologías para su implementación. Se utilizó AUP-UCI como metodología de desarrollo, Java como lenguaje de programación y otras tecnologías libres y multiplataforma. El patrón arquitectónico implementado fue modelo-vista-controlador. El módulo de Medios de Diagnóstico del sistema XAVIA HIS, permite el soporte de los procesos de atención al paciente y la integración de la información sobre los medios de diagnóstico, además fomenta un aumento en la calidad del servicio. El módulo facilita la configuración de aspectos de solicitud e informe de las pruebas diagnósticas y la planificación de horarios y citas(AU)

Hospital Information System XAVIA HIS developed by the Medical Informatics Center (CESIM) is made up of modules that ensure the computerization of hospital institution areas processes. Currently, the management of the main diagnostic means is realized in a dispersed way in different modules or systems. This paper presents the Diagnostic Means module, development that allows the requests and results reports management in a configurable way, as well as the schedules planning and appointments management. The business process associated with the diagnostic means information management was analyzed, an existing systems study with similar purposes was carried out, and technologies for their implementation were evaluated. AUP-UCI were used as development methodology, Java as programming language and other free and multiplatform technologies. The architectural pattern implemented was model-view-controller. The XAVIA HIS system Diagnostic Means module, allows the patient care processes support and integration of information regarding diagnostic means, also encourages an increase in the service quality. The module facilitates the request and report aspects configuration of the diagnostic tests and the schedules and appointments planning(AU)

Módulo Programas Médicos para el Sistema de Información Hospitalaria XAVIA HIS / Module Medical Programs for the XAVIA HIS Hospital Information System

La prestación personalizada de los servicios de salud resulta cada vez más atractiva y eficiente. El empleo de las herramientas informáticas para facilitar este propósito es una necesidad de las instituciones de salud. El Sistema de Información Hospitalaria XAVIA HIS es un ejemplo de la relación entre las necesidades de las instituciones de salud y la evolución funcional del mismo. Sin embargo, en el sistema no se ha concebido la posibilidad de planificar un protocolo que especifique los cuidados y procedimientos que deben realizarse en función del estado de salud del paciente. El trabajo presenta el desarrollo del módulo Programas Médicos para el sistema XAVIA HIS, que permite mejorar la gestión de la información generada durante el procesamiento de los programas médicos en las instituciones hospitalarias. Se realizó el análisis de los procesos de negocio asociados a la gestión de los programas médicos, se empleó como metodología de desarrollo AUP-UCI, JBoss Developer Studio, Java, JBoss como servidor de aplicaciones, PostgreSQL como sistema gestor de bases de datos y Visual Paradigm como herramienta CASE. Como resultado se obtuvo el módulo Programas médicos para el sistema XAVIA HIS, que permite la configuración de un programa médico a un paciente con una determinada enfermedad agrupando varios servicios, procedimientos, investigaciones clínicas por cada área del hospital(AU).

The health services personalized provision is becoming increasingly attractive and efficient. The computer tools used to facilitate this purpose is a necessity for health institutions. The Hospital Information System XAVIA HIS is an example of the relationship between the health institutions needs and its functional evolution. However, the system has not conceived the possibility of planning a protocol that specifies the care and procedures that must be performed depending on patient health condition. The paper presents the development of the Medical Programs module for the XAVIA HIS system, which allows to improve the management of information generated during the medical programs processing in hospital institutions. For this work development, an analysis of the business processes associated with the medical programs management was carried out; AUP-UCI was used as development methodology, JBoss Developer Studio, Java, JBoss as an application server, PostgreSQL as database management system and Visual Paradigm as a CASE tool. As a result, the Medical Programs module for the XAVIA HIS system was obtained, which allows the medical program configuration for a patient who has a certain disease, grouping several services, procedures, clinical investigations for each hospital area(AU)

Propuesta de nuevas funcionalidades para la gestión de la Historia Clínica Electrónica en el sistema XAVIA HIS / New features proposal to the Electronic Health Record management in the XAVIA HIS system

La digitalización de la historia clínica, documento indispensable en la atención de salud y que posee carácter legal, es uno de los focos de atención en la e-Salud. El sistema XAVIA HIS compuesto por módulos que informatizan los procesos e interconectan las diferentes áreas de una institución hospitalaria, posee como atributo fundamental, una historia clínica electrónica única por paciente. Esta se compone por documentos basados en el estándar HL7-CDA. Sin embargo, el sistema XAVIA HIS presenta algunas limitantes en la interacción con otras aplicaciones que gestionen la información de salud. En el trabajo se presentan las modificaciones a realizar al Sistema de Información Hospitalaria XAVIA HIS para mejorar la capacidad de gestión de las historias clínicas electrónicas del sistema. Se realizó un análisis de la literatura disponible sobre la gestión de las HCE y se evaluó el mecanismo que emplean sistemas homólogos nacionales e internacionales. Para guiar el desarrollo de la propuesta se empleó la metodología AUP-UCI; UML se empleó para el modelado de los artefactos de ingeniería y BPMN como lenguaje de notación para los procesos de negocio. Las modificaciones que se presentan, le permitirán al sistema XAVIA HIS interactuar con sistemas externos que generen documentos HL7-CDA. Adicionalmente, se añaden funcionalidades para mejorar la impresión de documentos clínicos que se exportan, así como la generación de resúmenes de la historia clínica(AU)

One of the e-Health approaches is the digitalization of the medical record, an essential document in health care and with a legal character. The XAVIA HIS system, made up of modules to manage the processes and interconnect the different areas of a hospital institution, has as a fundamental attribute, a unique electronic medical record per patient. It is made up of documents based on the HL7-CDA standard. However, the XAVIA HIS system presents some limitations to interaction with other applications also managing health information. This paper presents the new features and changes to be made to the Hospital Information System XAVIA HIS to improve the electronic medical records management of the mentioned system. An analysis of the available literature on EHR management was carried out and the mechanism used by national and international counterpart systems was evaluated. To guide the development of the proposal, the AUP-UCI methodology was used; UML was used for modeling the engineering artifacts and BPMN as a notation language for business processes. The modifications that are presented will allow the XAVIA HIS system to interact with external systems which also generate HL7-CDA documents. Additionally, functionalities are added to improve the printing of clinical documents that are exported, as well as the generation of summaries of the medical record(AU)

Design of a Hospice Referral System for Terminally Ill Cancer Patients Using a Standards-Based Health Information Exchange System / 대한의료정보학회지

OBJECTIVES: The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. METHODS: Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. RESULTS: Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. CONCLUSIONS: Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.

Technology and Policy Challenges in the Adoption and Operation of Health Information Exchange Systems / 대한의료정보학회지

OBJECTIVES: This study aimed to identify problems and issues that arise with the implementation of online health information exchange (HIE) systems in a medical environment and to identify solutions to facilitate the successful operation of future HIE systems in primary care clinics and hospitals. METHODS: In this study, the issues that arose during the establishment and operation of an HIE system in a hospital were identified so that they could be addressed to enable the successful establishment and operation of a standard-based HIE system. After the issues were identified, they were reviewed and categorized by a group of experts that included medical information system experts, doctors, medical information standard experts, and HIE researchers. Then, solutions for the identified problems were derived based on the system development, operation, and improvement carried out during this work. RESULTS: Twenty-one issues were identified during the implementation and operation of an online HIE system. These issues were then divided into four categories: system architecture and standards, documents and data items, consent of HIE, and usability. We offer technical and policy recommendations for various stakeholders based on the experiences of operating and improving the online HIE system in the medical field. CONCLUSIONS: The issues and solutions identified in this study regarding the implementation and operate of an online HIE system can provide valuable insight for planners to enable them to successfully design and operate such systems at a national level in the future. In addition, policy support from governments is needed.

Integração com monitores de beira de leito utilizando health level 7 / Integration with bedside monitors using health level 7 / Integración de monitores de cabecera utilizando health level 7

OBJETIVOS: desenvolver solução para integração de monitores de beira de leito ao Sistema de Informações Hospitalares (SIH). MÉTODOS: Desenvolvimento e implementação de troca de mensagens no padrão Health Level 7, Admit Discharge Transfer (ADT) e Observation (OBX), utilizando a biblioteca HAPI, para cadastro do paciente e coletados parâmetros de monitoramento. Criação de base de dados para seleção e armazenamento dos parâmetros desejados. RESULTADOS: cadastro integrado com o SIH e captura em banco de dados dos parâmetros dos monitores de beira de leito além de interface de teste para visualização dos dados. CONCLUSÃO: Desenvolvido e implementado um sistema para a integração com monitores beira de leito, permitindo uma visão mais abrangente dos dados dos pacientes.

OBJECTIVES: develop solution for integration of bedside monitors to the Hospital Information System (HIS). METHODS: Development and implementation of the exchange of messages using the standard Health Level 7, Admit Discharge Transfer (ADT) and Observation (OBX), using the HAPI library in order to register the patient and to collect parameters from the monitors. It was also created a database in order to support the selection and storage of the desired parameters. RESULTS: registration integrated with HIS and saving of bedside monitors' parameters in database plus test interface for data visualization. CONCLUSION: Developed and implemented a system to integrate with bedside monitors, allowing a more comprehensive view of patient data.

Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care / 대한의료정보학회지

OBJECTIVES: To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. METHODS: This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. RESULTS: Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. CONCLUSIONS: This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.

Developing a Common Health Information Exchange Platform to Implement a Nationwide Health Information Network in South Korea / 대한의료정보학회지

OBJECTIVES: We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS: By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS: As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS: We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.

Current National Approach to Healthcare ICT Standardization: Focus on Progress in New Zealand / 대한의료정보학회지

OBJECTIVES: Many countries try to efficiently deliver high quality healthcare services at lower and manageable costs where healthcare information and communication technologies (ICT) standardisation may play an important role. New Zealand provides a good model of healthcare ICT standardisation. The purpose of this study was to review the current healthcare ICT standardisation and progress in New Zealand. METHODS: This study reviewed the reports regarding the healthcare ICT standardisation in New Zealand. We also investigated relevant websites related with the healthcare ICT standards, most of which were run by the government. Then, we summarised the governance structure, standardisation processes, and their output regarding the current healthcare ICT standards status of New Zealand. RESULTS: New Zealand government bodies have established a set of healthcare ICT standards and clear guidelines and procedures for healthcare ICT standardisation. Government has actively participated in various enactments of healthcare ICT standards from the inception of ideas to their eventual retirement. Great achievements in eHealth have already been realized, and various standards are currently utilised at all levels of healthcare regionally and nationally. Standard clinical terminologies, such as International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) have been adopted and Health Level Seven (HL7) standards are actively used in health information exchanges. CONCLUSIONS: The government to New Zealand has well organised ICT institutions, guidelines, and regulations, as well as various programs, such as e-Medications and integrated care services. Local district health boards directly running hospitals have effectively adopted various new ICT standards. They might already be benefiting from improved efficiency resulting from healthcare ICT standardisation.

Implementación de estándares DICOM SR y HL7 CDA para la creación y edición de informes de estudios imagenológicos / Implementation of DICOM SR and HL7 CDA standards for the creation and edition of digital imaging reports

La aparición de nuevas tecnologías de la información, así como estándares y acuerdos, permite la interoperabilidad entre aplicaciones de sistemas de salud en distintas partes del mundo. El presente artículo introduce un estudio que pretende facilitar el uso de estándares y tecnologías disponibles hacia el sector salud, especialmente hacia instituciones hospitalarias. El trabajo parte del uso de los estándares HL7 CDA y DICOM SR para la edición de informes de estudios imagenológicos, debido a que la emisión de estos informes constituye una de las actividades fundamentales de los departamentos de diagnósticos por imágenes. Se describen las principales funcionalidades y características, como base para un sistema informático capaz de adaptarse a los distintos ambientes y escenarios, permitiendo agilizar y estandarizar el proceso que se informatiza. Con la implementación de estos estándares se lograrían sistemas con fuertes características de estandarización, generalidad, flexibilidad, accesibilidad, bajo costo de implementación, bajas necesidades en infraestructura, perdurables en el tiempo e independientes al cambio de la tecnología(AU)

As new information technologies, standards and agreements appear, it has been possible to increase the interoperability among applications in health care systems in the world. This article shows a study that aims to facilitate the use of standards and technologies that are available to the health care field, mainly in hospitals. The work is focused on the usage of HL7 CDA and DICOM SR standards to the edition of reports from imaging studies, because the issuance of these reports is one of the core activities at the departments of imaging diagnostics. The paper describes the main functionalities and features as a basis for a computer system capable of adapt to different environments and scenarios, allowing streamline and standardize the process to be computerized. With the implementation of these standards, highly standardized systems would be achieved, and also features as generality, flexibility, accessibility, low implementation cost, low infrastructure needs, long-lasting and independence of technology change(AU)

Research on medical instrument information integration technology based on IHE PCD / 生物医学工程学杂志

Integrating medical instruments with medical information systems becomes more and more important in healthcare industry. To make medical instruments without standard communication interface possess the capability of interoperating and sharing information with medical information systems, we developed a medical instrument integration gateway based on Integrating the Healthcare Enterprise Patient Care Device (IHE PCD) integration profiles in this research. The core component is an integration engine which is implemented according to integration profiles and Health Level Seven (HL7) messages defined in IHE PCD. Working with instrument specific Javascripts, the engine transforms medical instrument data into HL7 ORU message. This research enables medical instruments to interoperate and exchange medical data with information systems in a standardized way, and is valuable for medical instrument integration, especially for traditional instruments.

Establishing semantic interoperability between HL7 v2. x and V3: a communication standards ontology (CSO) / Estabelecer a interoperabilidade semântica entre HL7 v2.x e V3: uma ComunicaçãoOntology Standards (CSO) / Establecimiento de la interoperabilidad semántica entre HL7 v2.x y v3: una Comunicación Normas deOntología (OSC)

Different communication standards in healthcare - esp. HL7 version 2.x and v3 - lack inter- and intra-family compatibility. Bridging between those to establish semantic interoperability using a formal ontology as a mediator in a mapping process has demonstrated that both communication standards have in principle the same underlying architecture. This paper shortly analyses this structure in order to create a communication standards ontology (CSO) based on (basic) formal ontologies (BFO/FO) which is presented thereafter. The paper discusses problems which appeared during the development process and the established solution.

Diferentes padrões de comunicação em saúde como o HL7 versão 2 e a versão 3, falham em compatibilidade inter e intrafamiliar. Unificações entre a interoperabilidade semântica estabelecida usando uma ontologia formal como um mediador no processo de mapeamento tem demonstrado que os padrões de comunicação tem em princípio, a mesma arquitetura de apoio. Este artigo analisa brevemente esta estrutura para criar um padrão de ontologia de comunicação baseado em ontologias formais apresentadas. O artigo discute problemas que surgiram durante o processo de desenvolvimento e a solução estabelecida.

Los diferentes patrones de comunicación para la salud como la versión 2 de HL7 y la versión 3, no a la compatibilidad inter e intra-familiar. Unificaciones entre la interoperabilidad semántica realiza mediante una ontología formal como médico en el proceso de asignación ha demostrado que los patrones de comunicación son, en principio, compatibles con la arquitectura misma. En este artículo se considera que esta estructura para crear una ontología estándar de la Comunicación basados en ontologías formales presentadas. El artículo analiza los problemas que surgieron durante el proceso de desarrollo y el conjunto de soluciones.

Interoperability in disaster medicine and emergency management / Interoperabilidade em Medicina de Desastres e Administração de Emergência

Accurate and timely information is critical for health early warning and effective emergency management. Health Information Technology (HIT) standards address the challenge of integrating information from disparate healthcare resources e.g. devices, people, and information systems to support not only the effective handling of emergencies, but also their analysis for long-term resource planning. In the management of emergencies, co-operative use of standards facilitates effective sharing of information among the parties involved in search and rescue, continuous disaster assessment, and public awareness. This paper discusses the cooperative use of interoperability standards from Health Level Seven (HL7), the Organization for the Advancement of Structured Information Standards (OASIS), the European Committee for Standardization (CEN), and other Standards Developing Organizations to harness the power of Information and Communication Technologies (ICT) in emergency preparedness and response. The paper reports on the experience gained from the deployment of ICT in the Satellites for Epidemiology and health early warning (SAFE) civil protection exercise and interoperability considerations in technical solutions to be deployed in the ?POSEIDON? exercise (earthquake followed by tsunami in the Mediterranean) still at the planning stage.

Informações acuradas e na hora oportuna são essenciais para a emissão de alertas precoces de saúde e para a gestão eficaz de situações de calamidade pública. Os padrões de Tecnologia da Informação em Saúde objetivam resolver o desafio de integrar informações de diferentes recursos de saúde, como por exemplo dispositivos, pessoas e sistemas de informação para apoiar não só o tratamento eficaz nas situações de emergência, mas também na sua análise, para planejamento de recursos de longo prazo. Na gestão de emergências, o uso cooperativo de padrões facilita o compartilhamento eficaz de informações entre as partes envolvidas na busca e salvamento, de avaliação de desastres e conscientização pública. Este artigo discute o uso cooperativo de padrões de interoperabilidade do Health Level Seven (HL7), do Organização para o Avanço de Padrões de Informação Estruturados (OASIS), Comité Europeu de Normalização (CEN), e outras normas das organizações produtoras de padões para fortalecer o poder de Tecnologias de Informação e Comunicação (TICs) na preparação e resposta a emergências. O artigo relata a experiência adquirida com a utilização das TIC nos satélites de Epidemiologia e de alerta precoce de saúde (SAFE) exercício de protecção civil e os aspectos da interoperabilidade nas soluções técnicas a serem implantados no exercício ?Poseidon? (terremoto seguido de tsunami no Mediterrâneo) ainda em fase de planejamento...

HL7 in personal health system component's integration for mental health treatment / HL7 como componente de integração em Sistema de PEP para tratamento em Saúde Mental

Help4Mood is a project inside 7th European Framework Programme (FP7) for developing a computational distributed system to support remotely the treatment of patients with major depression at home. Core components are integrated with Health Level Seven (HL7) standard. One of the main goals of this system is to use the paradigm of a Virtual Agent to support the first symptoms of clinician alert of a patient, to interact with him an to prevent some causes of relapse. The system processes inputs from different devices (to monitor sleeping, eating and motor activity) in a decision support system, and the Virtual Agent interacts with the patient before clinical support from hospital is needed. The technical framework is using the open source HL7-standard-based healthcare integration engine, Mirth Connect, to interact with the different subsystems, analyze data and give different priorities for messages in queues. Particularly, the use of standard HL7 will contribute to interest in the project results and the potential impact through the development, dissemination and use, as stated in the analysis of the European commission.

Help4Mood é um projeto do 7 º Programa de Framework Europeu (FP7) para desenvolvimento de um sistema computacional distribuído para apoio remoto de tratamento domiciliar de pacientes com depressão. Os principais componentes são integrados com o padrão Health Level Seven (HL7). Um dos objetivos principais deste sistema é a utilização do paradigma de um agente virtual para apoiar os primeiros sintomas de alerta clínico de um paciente, interagirindo com ele de forma a impedir que algumas ocorrências de recaída. O sistema processa as entradas de dispositivos diferentes (para monitorar a dormir, comer e atividade motora) em um sistema de apoio à decisão, e o Agente Virtual interage com o paciente antes que o atendimento clínico hospitalar seja necessário. O framework usa o código-fonte ?open source? como motor de integração baseado no padrão HL7, chamado ?Mirth Connect? a fim de interagir com os diferentes subsistemas, analisar os dados, e dar prioridades diferentes para as mensagens enviadas. A utilização do padrão HL7, por certo, contribuirá para os resultados do projeto e o impacto potencial através do desenvolvimento, difusão e utilização, como referenciado na análise da Comissão Europeia do programa.

Almacenamiento externo de los datos patronímicos de un CDA / External storage of the patronymic data on a CDA

En el Uruguay el Decreto Nº 396/003 sobre Historia clínica electrónica establece que los datos patronímicos tienen que separarse de los datos clínicos salvo contexto de atención medica, el CDA es un documento que normalmente contiene ambos. Utilizamos esta especificación para registrar el documento clínico referente a la ?descripción operatoria?, restringiendo lo patronímico a un solo identificador, el cual permite encontrar los datos almacenados en otro sistema desacoplado. La conciliación del identificador con la información patronímica, se realiza mediante transacciones IHE pertenecientes al perfil PDQ de forma transparente al usuario autorizado, que edita o revisa el documento.

In Uruguay, the Decree No. 396/003 on electronic medical records states that patronymic data must be separated from clinical data except in the medical care context, the CDA is a document that typically contains both. We use this specification to record the clinical document regarding ?operative description?, restricting the patronymic information to a single identifier, which allows to find data stored on another disengaged system. Reconciliation of the identifier with the patronymic information is effected through IHE transactions belonging to the PDQ Profile which it is done transparently to the user authorized to edit or revise the document.

The Development of Clinical Document Standards for Semantic Interoperability in China / 대한의료정보학회지

OBJECTIVES: This study is aimed at developing a set of data groups (DGs) to be employed as reusable building blocks for the construction of the eight most common clinical documents used in China's general hospitals in order to achieve their structural and semantic standardization. METHODS: The Diagnostics knowledge framework, the related approaches taken from the Health Level Seven (HL7), the Integrating the Healthcare Enterprise (IHE), and the Healthcare Information Technology Standards Panel (HITSP) and 1,487 original clinical records were considered together to form the DG architecture and data sets. The internal structure, content, and semantics of each DG were then defined by mapping each DG data set to a corresponding Clinical Document Architecture data element and matching each DG data set to the metadata in the Chinese National Health Data Dictionary. By using the DGs as reusable building blocks, standardized structures and semantics regarding the clinical documents for semantic interoperability were able to be constructed. RESULTS: Altogether, 5 header DGs, 48 section DGs, and 17 entry DGs were developed. Several issues regarding the DGs, including their internal structure, identifiers, data set names, definitions, length and format, data types, and value sets, were further defined. Standardized structures and semantics regarding the eight clinical documents were structured by the DGs. CONCLUSIONS: This approach of constructing clinical document standards using DGs is a feasible standard-driven solution useful in preparing documents possessing semantic interoperability among the disparate information systems in China. These standards need to be validated and refined through further study.

The Development of a Graphical User Interface Engine for the Convenient Use of the HL7 Version 2.x Interface Engine / 대한의료정보학회지

OBJECTIVES: The Health Level Seven Interface Engine (HL7 IE), developed by Kyungpook National University, has been employed in health information systems, however users without a background in programming have reported difficulties in using it. Therefore, we developed a graphical user interface (GUI) engine to make the use of the HL7 IE more convenient. METHODS: The GUI engine was directly connected with the HL7 IE to handle the HL7 version 2.x messages. Furthermore, the information exchange rules (called the mapping data), represented by a conceptual graph in the GUI engine, were transformed into program objects that were made available to the HL7 IE; the mapping data were stored as binary files for reuse. The usefulness of the GUI engine was examined through information exchange tests between an HL7 version 2.x message and a health information database system. RESULTS: Users could easily create HL7 version 2.x messages by creating a conceptual graph through the GUI engine without requiring assistance from programmers. In addition, time could be saved when creating new information exchange rules by reusing the stored mapping data. CONCLUSIONS: The GUI engine was not able to incorporate information types (e.g., extensible markup language, XML) other than the HL7 version 2.x messages and the database, because it was designed exclusively for the HL7 IE protocol. However, in future work, by including additional parsers to manage XML-based information such as Continuity of Care Documents (CCD) and Continuity of Care Records (CCR), we plan to ensure that the GUI engine will be more widely accessible for the health field.

Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability / 대한의료정보학회지

OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.